Jojy Cheriyan MD, MPH--February 8, 2015

Stomach sleepers with epilepsy may be at higher risk of sudden unexpected death, according to a study published recently (January 21, 2015, published online prior to print) in the Journal Neurology, which is the mouth piece of American Academy of Neurology. Though this study examined data related to adult patients, the conclusion parallels with the Sudden Infant Death Syndrome (SIDS) in babies who sleep on their bellies.

Some case reports point to the fact that sudden unexpected death is the main cause of death in uncontrolled epilepsy, and usually occurs during un-witnessed sleep. People with tonic-clonic seizures (formerly called grand mal seizures) that affect the entire brain are more likely to die suddenly than people with partial seizures that affect only a part of the brain.

For the current study, researchers reviewed 25 studies that included 253 sudden unexpected death cases where body position was recorded as prone-position (sleeping on stomach).

Among the people died, the study found that 73 percent of the cases died in the stomach sleep position, whereas 27 percent died in other sleep positions. Further analysis also found that people younger than 40 were four times more likely to be found on their stomachs at the time of sudden death than people over 40. This could be due to the fact that young people have more tendency to sleep on their bellies than older people. Researchers also found that death was more likely to be among single and those who didn't have anyone with them during a seizure while sleeping.

In the literature review, the researchers also found that a total of 11 cases of sudden death have occurred while the people were being monitored with video EEG and their sleeping position was recorded. In all those cases, the people died were sleeping on their stomachs before the terminal seizures.

This could also be to the fact that adults may find it difficult to get up or turn the body to supine-position soon after the seizure-attack. Post-seizure motor (muscle) weakness is quite common after tonic-clonic seizure. Lying on stomach may also inhibit the accessory respiratory muscles (like chest muscles and abdominal muscles) to work with full strength to assist breathing.

The study authors suggest that the most important strategy for preventing sudden unexpected death in epilepsy is to sleep on back (supine-position). Using wrist watches and bed alarms designed to detect seizures during sleep may also help prevent these deaths.